Bone Marrow Aspiration and Biopsy

Carolyn Vachani, RN, MSN, AOCN Abramson Cancer Center of the University of Pennsylvania

What is bone marrow?

Bone marrow is a spongy substance found inside our large bones, such as the femur (thigh), hips, and ribs. It is made up of cells called hematopoietic stem cells. Hematopoietic stem cells are "baby" cells that grow up to become either white blood cells, red blood cells, or platelets. The bone marrow acts as a greenhouse for these cells, growing them and storing them until they are needed. Unfortunately, sometimes cancer cells can find their way into the bone marrow, making it difficult for the marrow to do its job of producing healthy blood cells.

What is a bone marrow biopsy?

Bone marrow aspiration and biopsy are tests to check the function of your bone marrow or to check for the presence of cancer cells. Bone marrow aspiration involves using a needle to take a sample of bone marrow fluid from inside the bone. Bone marrow biopsy involves using a needle to take a small sample of the bone and marrow. These samples are then examined under a microscope. This may be done before therapy to assess the condition of the marrow or after treatment to assess the response to treatment.

What can I expect during the procedure?

The procedure is done by a physician or nurse practitioner in your hospital room or in the outpatient clinic. The area used for a bone marrow aspirati on is the hip or breast bone. The area used for the bone marrow biopsy is your hip. You will be asked to lay on your stomach or side, so the area can be reached easily. Your nurse practitioner or doctor will explain the procedure as it is performed, but these are the steps, so you will know what to expect.

The skin will be cleaned with an antiseptic soap, which might feel cold.

The area where the sample will be taken will be "numbed" with lidocaine. The lidocaine may burn but this feeling only lasts a few seconds. A small needle is used to give the numbing medicine in the area.

After the numbing medicine has had a few minutes to take effect, a needle will be inserted into the bone and bone marrow fluid will be taken out with a syringe. You may feel a pulling or drawing sensation down the leg whi le the sample is being taken. This will only last a few seconds.

If a biopsy is ordered, it is done immediately before or after the aspiration by inserting a needle into the bone and removing a small sample. This part of the procedure does not cause the sensation of pulling, but you may feel the pressure of the needle.

In most cases, the procedure takes 20 - 30 minutes. A bandage will be applied to the area after the procedure.

After the numbing medicine wears off, you may feel some discomfort at the site of the needle insertion. Walking may lessen this discomfort.

Instructions for after the procedure:

Keep the bandage clean and dry for 24 hours. After this time, you can remove the bandage and bathe or shower.

If bleeding occurs after your bone marrow aspiration or biopsy, apply pressure to the area and call your doctor.

Call your doctor if pain persists for greater than 24 hours in the area where you had your biopsy or aspiration.

Call your doctor immediately if you notice redness or drainage at the site or if you have a fever.

Call your doctor if you have numbness or weakness in the area where you had the bone marrow or down your leg.

Please do not hesitate to ask your doctor or nurse if you have any additional questions.